Mismanagement Quizzo – Pharma Edition

You know, it seems like it wasn’t all that long ago that Martin Shkreli of Turing Pharmaceuticals was considered “the most hated man in America.”[1]

Recall that Shkreli was the executive who raised the price of Daraprim, a decades old drug used in the treatment of a rare parasitic infection called toxoplasmosis. It’s relied upon by AIDS patients and other individuals with compromised immune systems. That increase—from $13.50 per pill to $750—earned Shkreli a mention in a recent addition of “Mismanagement Quizzo” on this blog. (Keep in mind too that neither Turing nor Shkreli contributed to the development of this drug.)

This week, an “all pharma” addition of Mismanagement Quizzo – in part because if you’ve been following the news recently, you know that Shkreli isn’t alone in engaging in this sort of price gouging…and in part as a nod to the industry in which yours truly was once employed.

(By the way, Shkreli was forced to resign in December of 2015 after being charged with securities fraud. He is currently awaiting trial after posting a $5 million bond.[2])

And so…

(3 points for every correct answer; 1 point for each bonus answer)

This pharmaceutical company engaged in “Shkreli-like” practices when it raised the price of a two pack of EpiPens—an auto-injector that delivers the generic drug epinephrine used to treat severe allergy reactions—from about $100 to $600.

Bonus question: Name the company’s now unpopular CEO (pictured above testifying before Congress), and give yourself an extra bonus point if you know what she received in compensation last year.

This company also “Shkrelied” patients by raising its drug prices, but in this case almost across the board. Those products include Nitropress and Isuprel (both heart medications), and Cuprimine (which is used to treat a rare genetic disorder).

Bonus question: The CEO responsible, J. Michael Pearson, was ousted in March of this year. Name his successor.

This pharmaceutical company was recently sued by the Federal Trade Commission for engaging in so-called “pay-to-delay” practices, thereby blocking consumer’s access to lower cost generic versions of two of its drugs, Opana ER and Lidoderm.

Bonus question: What are these two medications used in the treatment of?

This consumer health company and it’s founder and CEO Elizabeth Holmes were media darlings until its blood-testing technology failed to live up to its claims, forcing them to void tens of thousands of blood tests in 2014 and 2015.

Bonus question: What did this start-up do instead when their proprietary technology—which only requires a tiny finger prick of blood—didn’t work?

Two former employees of this pharmaceutical company—Jonathon Roper and Fernando Serrano—were arrested on federal anti-kickback charges in June of this year. Prosecutors alleged that they had paid doctors thousands of dollars to participate in “sham” educational programs in exchange for prescribing millions of dollars worth of Subsys, a spray that contains a powerful painkiller known as fentanyl, and which is this company’s only product.

Bonus question: For what other reason was the drug fentanyl recently in the news?

Answers:

Mylan Pharmaceuticals. Recently, the company has been accused of encouraging not-for-profits to urge lawmakers to add Epipens to a federal list of preventative medical devices. Such a move could mute the public outcry by eliminating the out-of-pocket costs of the device for individuals and families, but the federal government, health insurers, and employers would then be footing the bill instead – thereby allowing Mylan to continue to overcharge for its product.

Bonus: CEO Heather Bresch received nearly $19 million in compensation in 2015. In a recent interview, she was unapologetic about being motivated by profit: “I am running a business. I am a for-profit business. I am not hiding from that.”

Valeant Pharmaceuticals. In 2015, Valeant raised the price of Nitropress and Isuprel 212% and 525%, respectively, shortly after acquiring both. Last summer they quadrupled the price of Cuprimine, a drug that has been around for 55 years. And flucytosine, a generic antifungal medication they also own, is 100-fold more expensive in the US than it is in the UK, or Europe.

Bonus: Joseph C. Papa was recently named as Pearson’s successor. However, his former company, Perrigo, has engaged in Valeant-like practices in the past, including merging with a foreign company to slash its tax rate.

Endo Pharmaceuticals. The FTC complaint alleges that in 2010, Endo paid Impax Laboratories $112 million not to market an authorized generic version of Opana ER until 2013. (In 2010, sales for Opana ER exceeded $250 million.) It also alleges that in May 2012, Endo compensated Watson Laboratories to the tune of $96 million to not market a generic version of Endo’s Lidoderm patch until September 2013. (In 2012, Lidoderm sales in the US approached $1 billion.)

Bonus: Both are pain relief medications. Opana ER is an opioid agonist used to manage severe pain, and Lidoderm (aka lidocaine) is a local anesthetic used to relieve post-shingle pain.

Theranos. According to an article in Vanity Fair, one patient in 2014 was sent to the emergency room after receiving “abnormally elevated test results” from a Theranos blood-testing machine. Geoffrey Baird, a professor of laboratory medicine at the University of Washington in Seattle told The Wall Street Journal: “There have been massive recalls of single tests in the past, but I’m not aware of one where a company recalled the entirety of the results from its testing platform. I believe that’s unprecedented.”

Bonus: According to the same paper, after the company’s devices failed its own accuracy requirements, Theranos abandoned their technology and began using traditional, commercially available machines purchased from other companies.

Insys Therapeutics. According to a New York Times article by Katie Thomas, when Insys was in danger of falling short of its sales goals for the first time in 2014, Mr. Roper sent out an email stating the following: “There is no excuse for your docs to not take care of you at this crucial time.” Those doctors, he furthermore argued, needed to “give back for all of the hard work, long days and late nights you have spoiled them with.” According to the same report, events at which doctors spoke had bogus sign-in sheets with forged signatures to make those events look legitimate. One top prescriber was allegedly paid $147,245 in speaking fees, and another $112,340. Together, they accounted for $2.6 million in Subsys prescriptions that were reimbursed through Medicare.

Bonus: Rock legend Prince died of an overdose of the drug on April 21, 2016, although it is not clear what form he took. Fentanyl is a synthetic opioid estimated to have 80 times the potency of morphine.

Want to find out how you stack up? Then post your score in the comment section below…

That was a good read and included tidbits that brought to mind recent quotes from Trump and also the Wells Fargo scandal. Despite working in the industry I did terribly on the quiz-I’m hopeless at remembering company and officer names. I do, however, know my Prince trivia!